Tetanus Flashcards
Definition of Tetanus
A serious bacterial infection that causes painful muscle spasms and can lead to death.
Tetanus is a potentially fatal bacterial infection that affects the nerves. A vaccine can easily prevent the infection, which has no cure.
Tetanus is a serious disease of the nervous system caused by a toxin-producing bacterium. The disease causes muscle contractions, particularly of your jaw and neck muscles. Tetanus is commonly known as lockjaw.
Severe complications of tetanus can be life-threatening. There’s no cure for tetanus. Treatment focuses on managing symptoms and complications until the effects of the tetanus toxin resolve.
Tetanus is also called
Tetanus
Also called: lockjaw
Tetanus is an infection caused by bacteria called Clostridium tetani. When these bacteria enter the body, they produce a toxin that causes painful muscle contractions. Another name for tetanus is “lockjaw”. It often causes a person’s neck and jaw muscles to lock, making it hard to open the mouth or swallow.
Causes and How it gets into the body
— Clostridium tetani
Tetanus is an infection caused by a bacterium called Clostridium tetani. Spores of tetanus bacteria are everywhere in the environment, including soil, dust, and manure. The spores develop into bacteria when they enter the body. Unlike other vaccine-preventable diseases, tetanus is not spread from person to person.
Stepping on nails or other sharp objects is one way people are exposed to the bacteria that cause tetanus. These bacteria are in the environment and get into the body through breaks in the skin.
The spores can get into someone’s body through broken skin, usually through injuries. Tetanus bacteria are more likely to infect certain breaks in the skin. These include:
Wounds contaminated with dirt, feces (poop), or saliva (spit)
Puncture wounds (wounds caused by an object, like a nail or needle, breaking the skin)
Burns
Crush injuries (injury to a body part due to pressure from another object or being squeezed between two heavy objects)
Injuries with dead tissue
Tetanus bacteria can also infect someone’s body through breaks in the skin caused by:
Clean superficial wounds (when only the topmost layer of skin is scraped off)
Surgical procedures
Insect bites
Dental infections
Compound fractures (an exposed broken bone)
Chronic sores and infections
Intravenous (IV) drug use
Intramuscular injections (shots given in a muscle)
Time from exposure to illness
Time from exposure to illness
The incubation period — time from exposure to illness — is usually between 3 and 21 days (average 8 days). However, it may range from 1 day to several months, depending on the kind of wound. Most cases occur within 14 days. In general, doctors see shorter incubation periods with:
More heavily contaminated wounds
More serious disease
Symptoms of tetanus include:
Symptoms of tetanus include:
The first sign is most commonly spasms of the muscles of the jaw, or “lockjaw.
Jaw cramping
Sudden, involuntary muscle spasms — often in the stomach
Painful muscle 💪 stiffness all over the body
Trouble swallowing
Seizures (jerking or staring)
Headache 🤕
Fever and sweating 😓
Changes in blood 🩸 pressure and heart 🫀rate📈
Extreme sweating 😓
Symptoms
y Difficulty or inability to open mouth
y Constipation
y Stiffbody
y Spasms- these are painful and are triggered by noise, bright light or
touch; spontaneous in severe cases.
Signs
y Umbilicus may be infected
y Presence of wound (but may have healed) y Irritability
y Cyanosis during spasms
y Sardonic (mocking) smile
y Lock jaw (cannot open the mouth)
y Opisthotonus (stiff arched back)
y Rigid abdomen and stiff neck and limbs
Complications
Complications of tetanus infection may include:
Breathing problems. Life-threatening breathing problems can occur from tightening of the vocal cords and muscle rigidity in the neck and abdomen, especially during a generalized spasm.
Blockage of a lung artery (pulmonary embolism). A blood clot that has traveled from elsewhere in your body can block the main artery of the lung or one of its branches.
Pneumonia. A lung infection caused by accidentally inhaling something into the lungs (aspiration pneumonia) may be a complication of generalized spasms.
Broken bones. Generalized spasms may cause fractures of the spine or other bones.
Death. Death from tetanus is often caused by a blocked airway during spasms or damage to the nerves that regulate breathing, heart rate or other organ functions.
Serious health problems that can happen because of tetanus include:
Laryngospasm (uncontrolled/involuntary tightening of the vocal cords)
Fractures (broken bones)
Pulmonary embolism (blockage of the main artery of the lung or one of its branches by a blood clot that has travelled from elsewhere in the body through the bloodstream)
Aspiration pneumonia (a lung infection that develops when things like saliva or vomit accidentally go into the lungs)
Breathing difficulty
Tetanus can lead to death (1 to 2 in 10 cases are fatal).
Vaccination 💉
Tetanus is an uncommon but very serious disease caused by spores of bacteria found in the environment. Make sure you and your loved ones are up to date with your tetanus vaccination so you can enjoy being outdoors safely.
Vaccination is the best way to protect against tetanus
The United States sees an average of about 30 reported cases each year. Nearly all cases of tetanus are among people who did not get all the recommended tetanus vaccinations.
These vaccines help protect against tetanus and also provide protection against other diseases:
DTaP protects against diphtheria, tetanus, and pertussis (whooping cough)
DT protects against diphtheria and tetanus
Tdap protects against tetanus, diphtheria, and pertussis
Td protects against tetanus and diphtheria
CDC recommends tetanus vaccines for people of all ages
The vaccine recommended for someone depends on their age.
This graphic highlights CDC’s tetanus vaccination recommendations for young children, preteens, and adults.
Babies and young children should get five shots of DTaP between the ages of 2 months and 6 years. Children 6 years old and younger who should not get whooping cough vaccines can receive DT for protection against diphtheria and tetanus.
Preteens should get one shot of Tdap between the ages of 11 and 12 years.
All adults who have never received one should get a shot of Tdap. This can be given at any time, regardless of when they last got Td. This should be followed by either a Td or Tdap shot every 10 years.
Talk to a doctor if you have questions about tetanus vaccines.
Tetanus vaccines are safe
Most people who get a tetanus vaccine do not have any serious problems with it. However, side effects can occur. Most side effects are mild, meaning they do not affect daily activities. See the vaccine information statement for each vaccine to learn more about the most common side effects.
Vaccination for children
The tetanus vaccine is given to children as part of the diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). Diphtheria is a serious bacterial infection of the nose and throat. Acellular pertussis, also called whooping cough, is a highly contagious respiratory infection.
Children who do not tolerate the pertussis vaccine may receive the alternative vaccine called DT.
The DTaP is a series of five shots typically given in the arm or thigh to children at ages:
2 months
4 months
6 months
15 to 18 months
4 to 6 years
Vaccination for children ages 7 to 18
A booster shot is recommended for children at age 11 or 12. This booster is called the Tdap vaccine. If your child didn’t get a booster shot as this age, talk to your doctor about appropriate options.
Vaccination for adults age 19 and older
A booster shot is recommended for adults once every 10 years. This may be one of two vaccines, Tdap or Td. If you weren’t vaccinated against tetanus as a child or are unsure about your vaccination status, see your doctor about getting the Tdap vaccine.
Vaccination during pregnancy
A booster is recommended during the third trimester of a pregnancy, regardless of the mother’s vaccination schedule.
Other recommendations
Ask your doctor to review your vaccination status regularly.
Check whether you are current on your vaccination schedule if you are planning international travel.
Diagnosis & Treatment
Also view STG page 87
Diagnosis & Treatment
Diagnosis
Doctors can diagnose tetanus by asking about recent history of cuts, scrapes, punctures, and trauma, and examining someone for certain signs and symptoms. There are no hospital lab tests that can confirm tetanus.
Treatment
Tetanus is a medical emergency requiring:
Evaluation and care in the hospital
Immediate treatment with medicine called human tetanus immune globulin (TIG)
Aggressive wound care
Drugs to control muscle spasms
Antibiotics
Tetanus vaccination
Depending on how serious the infection is, a machine may be required to help someone with tetanus breathe.
Prevention
Prevention
Vaccination and good wound care are important to help prevent tetanus infection. Doctors can also use a medicine to help prevent tetanus when someone is seriously hurt and isn’t up to date with tetanus vaccination.
Vaccination
Being up to date with tetanus vaccination is the best tool to prevent tetanus. Protection from vaccines, as well as a prior infection, do not last a lifetime. This means people who had tetanus or got vaccinated before still need to get vaccinated regularly to keep a high level of protection against this serious disease. CDC recommends tetanus vaccines for people of all ages, with booster shots throughout life.
Good wound care
Immediate and good wound care can also help prevent infection.
Apply first aid to even minor, non-infected wounds like blisters, scrapes, or any break in the skin.
Wash hands often with soap and water or use an alcohol-based hand rub if washing is not possible.
Consult your doctor if you have concerns and need further advice.
Medicine
Doctors may use a type of medicine called human tetanus immune globulin (TIG) for someone who has an unclean wound and is not up to date with their tetanus vaccination. These medicines provide immediate protection from the type of bacteria that causes tetanus, but it is not long lasting.
Localized tetanus
This uncommon form of tetanus results in muscles spasms near the site of a wound. While it’s usually a less severe form of disease, it can progress to generalized tetanus.
Cephalic tetanus
This rare form of tetanus results from a head wound. It results in weakened muscles in the face and spasms of the jaw muscles. It also can progress to generalized tetanus.
Risk factors
Risk factors
The greatest risk factor for tetanus infection is not being vaccinated or not keeping up with the 10-year booster shots.
Other factors that increase the risk of tetanus infection are:
Cuts or wounds exposed to soil or manure
A foreign body in a wound, such as a nail or splinter
A history of immune-suppressing medical conditions
Infected skin lesions in people living with diabetes
An infected umbilical cord when a mother isn’t fully vaccinated
Shared and unsanitary needles for illegal drug use
Tetanus
Tetanus is a disease caused by a bacterium, which produces a neurotoxin responsible for the clinical features. These bacteria live predominantly in the soil, so it is easy to get this infection whenever a break in the skin is not cleaned properly. Tetanus-prone wounds include burns, puncture injuries, or those contaminated by soil/manure, septic wounds, and those with much devitalised tissue and compound fractures. The use of non-sterilised instruments or dressings on the umbilical cord predisposes to neonatal tetanus. The incubation period is 3-21 days.
Tetanus should be treated as a medical emergency. Tetanus immunisation is the key for prevention (See section on ‘Immunisation’).
Investigations
y No confirmatory test (diagnosis is clinical)
Alright
Tetanus Immunization 💉
Tetanus Immunisation
y Start Immunisation before discharge from hospital in all patients because tetanus infection does not provide immunity against future episodes
y An adult who has received a total of 5 doses of tetanus toxoid is likely to have life-long immunity
Tetanus Immunisation
y A course of tetanus toxoid vaccinations should be given to any previously unimmunised patient older than 2 years of age. Dose: 0.5 ml, IM or deep SC, repeat at 4 weeks and 8 weeks (primary course)
y If 10 or more years (5 or more years for children below age 15 years) have elapsed since primary course or last booster, give booster dose of 0.5 ml
y In tetanus-prone wounds start the primary course in the non-immunised
patient. A booster dose may be given if more than five years have elapsed
since the last dose
y Survivors of neonatal tetanus should follow the normal schedule for “Five-
in-One” (Penta-) vaccine
y Previously unimmunised children below the age of 2 years should receive 3
doses of 5 in 1 at intervals of four weeks.
y Cut umbilical cord with sterile instrument, clean with methylated spirit (al-
cohol) and leave uncovered
y To prevent tetanus in patients with potentially contaminated wounds (tet-
anus prone wound), provide adequate wound toileting (See section on
‘Wounds’) and also provide tetanus prophylaxis
y Tetanus Immunisation in pregnancy (See section on ‘Antenatal Care’)
